Organization
GENESEE VALLEY GROUP HEALTH ASSOCIATION
Active
Organization
GENESEE VALLEY GROUP HEALTH ASSOCIATION
Active
Other names
Lifetime Health Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH CARLASCIO (VICE PRESIDENT REGIONAL OPERATIONS)
(585) 338-1400
Entity
Organization
Contact information
Practice address
130 EMPIRE DR, WEST SENECA, NY 14224-1320
(716) 668-6170
(716) 656-4074
Mailing address
130 EMPIRE DR, WEST SENECA, NY 14224-1320
(716) 668-6170
(716) 656-4074
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
—
—
136A00000X
Registered Dietetic Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00011283017
GROUP # FOR HCP NUTRITION
NY
Enumeration date
03/22/2007
Last updated
09/11/2025
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